Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, Würzburg, 97080, Germany.
Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.
ESC Heart Fail. 2021 Aug;8(4):2802-2815. doi: 10.1002/ehf2.13352. Epub 2021 May 1.
The role of diastolic dysfunction (DD) in prognostic evaluation in heart failure (HF) patients with impaired systolic function remains unclear. We investigated the impact of echocardiography-defined DD on survival in HF patients with mid-range (HFmrEF, EF 41-49%) and reduced ejection fraction (HFrEF, EF < 40%).
A total of 2018 consecutive hospitalized HF patients were retrospectively included and divided in two groups based on baseline EF: HFmrEF group (n = 951, aged 69 ± 13 years, 74.2% male) and HFrEF group (n = 1067, aged 68 ± 13 years, 76.3% male). Clinical data were collected and analysed. All patients completed ≥1 year clinical follow-up. The primary endpoint was defined as all-cause death (including heart transplantation) and cardiovascular (CV)-related death. All-cause mortality (30.8% vs. 24.9%, P = 0.003) and CV mortality (19.1% vs. 13.5%, P = 0.001) were significantly higher in the HFrEF group than the HFmrEF group during follow-up [median 24 (13-36) months]. All-cause mortality increased in proportion to DD severity (mild, moderate, and severe) in either HFmrEF (17.1%, 25.4%, and 37.0%, P < 0.001) or HFrEF (18.9%, 30.3%, and 39.2%, P < 0.001) patients. The risk of all-cause mortality [hazard ratio (HR) = 1.347, P = 0.015] and CV mortality (HR = 1.508, P = 0.007) was significantly higher in HFrEF patients with severe DD compared with non-severe DD after adjustment for identified clinical and echocardiographic covariates. For HFmrEF patients, severe DD was independently associated with increased all-cause mortality (HR = 1.358, P = 0.046) but not with CV mortality (HR = 1.155, P = 0.469).
Echocardiography-defined severe DD is independently associated with increased all-cause mortality in patients with HFmrEF and HFrEF.
舒张功能障碍（DD）在收缩功能受损的心衰（HF）患者预后评估中的作用仍不清楚。我们研究了超声心动图定义的 DD 对射血分数中间值（HFmrEF，EF 41-49%）和射血分数降低（HFrEF，EF<40%）HF 患者生存的影响。
共回顾性纳入 2018 例连续住院 HF 患者，根据基线 EF 将其分为两组：HFmrEF 组（n=951，年龄 69±13 岁，74.2%为男性）和 HFrEF 组（n=1067，年龄 68±13 岁，76.3%为男性）。收集临床数据并进行分析。所有患者均完成了≥1 年的临床随访。主要终点定义为全因死亡（包括心脏移植）和心血管（CV）相关死亡。在随访期间，HFrEF 组的全因死亡率（30.8%比 24.9%，P=0.003）和 CV 死亡率（19.1%比 13.5%，P=0.001）明显高于 HFmrEF 组[中位随访时间 24（13-36）个月]。HFmrEF 或 HFrEF 患者中，随着 DD 严重程度的增加（轻度、中度和重度），全因死亡率呈比例增加（17.1%、25.4%和 37.0%，P<0.001）。调整了确定的临床和超声心动图协变量后，与非重度 DD 相比，HFrEF 患者重度 DD 与全因死亡率（危险比[HR]为 1.347，P=0.015）和 CV 死亡率（HR 为 1.508，P=0.007）显著升高相关。对于 HFmrEF 患者，重度 DD 与全因死亡率（HR 为 1.358，P=0.046）独立相关，但与 CV 死亡率（HR 为 1.155，P=0.469）无关。
超声心动图定义的重度 DD 与 HFmrEF 和 HFrEF 患者的全因死亡率增加独立相关。
